Revision surgery in pelvic discontinuity: an analysis of seven patients

The technical aspect and clinical outcome of seven patients with pelvic discontinuities in acetabular revision surgery after a mean followup of 96 months were analyzed. The surgical treatment consisted of three consecutive steps beginning with mechanical stabilization of the two acetabular columns, followed by bony acetabular reconstruction by filling the osteolytic defect with allograft chips covered with autologous bone to achieve a contained defect after healing of the autograft, and anchorage of the cup using an acetabular reinforcement ring (five with a hook, two without a hook). Complications included a partial ischial nerve lesion, one intraoperative femoral shaft fracture, and one recurrent dislocation. One patient had revision surgery 12 months after the first revision surgery because of aseptic loosening, and in one patient two prominent screws had to be removed. The clinical improvement according to the Harris hip score was 40.1 points on average (preoperative, 33 points; postoperative, 73.1 points). At the final followup all acetabular components were stable and the pelvic discontinuity had healed. Despite the technical feasibility of such revisions and the acceptable clinical results, the complication rate is high. Early diagnosis of acetabular loosening to minimize the osteolytic loss of bone stock is important.